22. Short procedures
22. Short procedures
The Tulip has been designed for use in day-case anaesthesia in conjunction with the rapid acting, and reflex suppressing Propofol intravenous induction agent. This agent usually allows excellent conditions for the insertion of a Tulip within 30 seconds of induction. The Tulip must be disposed of after single use, and requires no maintenance or sterilization. The Tulip is a single adult size device which means that there is never a situation of non-availability that may occasionally occur with other multi-size reusable or disposable devices.
The self-extubation mechanism that is recommended with the Tulip enables a lower level of intensive recovery staff attention, as the airway is secured and sealed if the Tulip has been left in-situ post operatively. The inflated cuff seals the oropharynx and protects the laryngeal inlet from descending saliva and other secretions until the fully awake Patient self-extubates when ready.
Normally in recovery other supraglottic airway devices have to be removed when the Patient is still semi-conscious to prevent the obstruction caused by a biting Patient as they recover. This is not an issue with the Tulip, as the Patient has recovered more fully before they remove the Tulip themselves and are no longer biting the tube. The Tulip is actually well tolerated by the recovered Patient when their eyes are open and when they are responding to direct verbal commands. In this scenario, the awake Patient normally does not gag as is the case with larger, deeper airway devices and instead swallows repeatedly with the Tulip still in-situ. Also the Tulip has no large, hard parts within the Patients mouth so its removal is easy even between clenched teeth, as the inflatable cuff simply deforms and slips out.
In Recovery, the secured, inflated Tulip normally removes the need for the chin lift maneuver that is usually required in recovery Patients and as the Patient removes the Tulip themselves when recovered and ready, the attendant no longer has to do this either. Also because the Tulip is removed by the fully recovered Patient in response to direct verbal command from the Recovery staff, the attendant normally no longer needs to maintain that Patients airway after removal, as is required for similar airway devices. The inflated Tulip also removes most of the internal secretions as it comes out of the mouth, lessening the requirement for attending staff to suction, reducing Patient trauma still further.
Currently in the case of E.N.T., oro-dental and facio-maxillary surgery the Patient is usually placed in the Trendelenburg position on the left side with a bleeding, insecure airway which requires considerable expertise to maintain. Normally with other airway devices the recovery staff need both to lift the chin and hold on to the oxygen mask whilst preventing aspiration and laryngospasm with regular controlled suction. This suction may in itself induce reflex stimulation which may induce coughing, laryngeal spasm or vomiting.
In the case of a Tulip, it is no longer obligatory to place the Patient in the left side, head down posture at all, as the inflated Tulip cuff confirms an air tight, ventilating seal. This seal may reliably be considered safe against descending blood and secretions if the seal tolerates the normal expected ventilating pressure of +/-20cmH2O. This then reduces the risks of injury to the Patient, as there is no need to reposition them post-operatively.
The inflated Tulip should be removed either by the recovering Patient overcoming the gentle resistance of an untied Tulip within the mouth or by an attending recovery staff member, though the former is preferred. This state of full cuff inflation allows the Tulip’s cuff to pull out any remaining upper pharyngeal and oral secretions out in front of itself as it is pulled out of the Patients mouth upon removal. The Tulip does not usually cause airway obstruction at any stage of introduction or removal, unlike other devices which may cause airway obstruction when they are within the mouth of a recovering Patient. This constantly available ventilating seal maximizes the ability to generate reliable manual ventilation until the very last moment of extubation, which gives added control and confidence.
The Tulip is designed to international safety standards and is CE marked. It is resistant to biting, but the basic design of a cuffed tubular lumen allows ventilation at all stages of entry and exit, unless the breathing lumen is itself occluded by a foreign body such as secretions, or is in direct contact with the oropharyngeal mucosa.
The inflated cuff reduces trauma on extubation by ensuring that the Patients oral-pharyngeal mucosa is only ever touched by a soft, inflated, high-volume, low-pressure, plastic balloon-cuff. These inherent abilities naturally endear the Tulip to a vast range of uses, environments and personnel, as intended.